white-coat hypertension
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Introduction
Hypertension attributed to the transient rise in blood pressure some individuals experience when being evaluated by a physician.
Definition:
- at least 3 separate office blood pressure measurements > 140/90 mm Hg with at least 2 separate blood pressure measurements < 140/90 outside of the office without evidence of target organ damage[1]
Etiology
- sympathetic nervous system activity mediates white-coat hypertension[11]
Epidemiology
- more common in elderly than in general population[4][8]
- accounts for 1/3 of resistant hypertension cases[5]
Diagnostic procedures
- ambulatory blood pressure monitoring is gold standard[5]
- electrocardiogram for evidence of LV hypertrophy if sustained chronic hypertension suspected
Radiology
- echocardiogram for evidence of LV hypertrophy if sustained chronic hypertension suspected
Complications
patients with white-coat hypertension
- experience clinical outcomes similar to patients with consistently normal blood pressure.[2]
- no evidence of increased cardiovascular events[6]
- are twice as likely as normotensive patients to develop hypertension (at home) within 8 years[3]
- true white coat hypertension is associated with mortality similar to normal blood pressure[7]
- elderly with white coat hypertension at risk for hypotension if inappropriately treated with antihypertensive(s)[8]
- white coat hypertension associated with 36% higher risk of cardiovascular event & 33% higher risk for mortality, compared with normotension[10]
- risks still lower than those in patients with sustained hypertension
- increased risk may apply only to high-risk older adults
- out-of-office BP monitoring needed to identify those with true white coat hypertension[10]
Management
- home blood pressure monitoring, especially the elderly
- 1 in-office, 2 out-of-office blood pressure measurements[7]
- monitor for emergence of sustained chronic hypertension or end organ damage[1]
- antihypertensive therapy generally not required[1]; of no benefit[12]
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2021
- ↑ Jump up to: 2.0 2.1 Journal Watch 24(8):64, 2004 Bobrie G et al Cardiovascular prognosis of "masked hypertension" detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 291:1342, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15026401
- ↑ Jump up to: 3.0 3.1 Ugajin T, Hozawa A, Ohkubo T, Asayama K, Kikuya M, Obara T, Metoki H, Hoshi H, Hashimoto J, Totsune K, Satoh H, Tsuji I, Imai Y. White-coat hypertension as a risk factor for the development of home hypertension: the Ohasama study. Arch Intern Med. 2005 Jul 11;165(13):1541-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16009871
- ↑ Jump up to: 4.0 4.1 Internal Medicine World Report 2006; 21(2)
- ↑ Jump up to: 5.0 5.1 5.2 de la Sierra A et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension 2011 May; 57:898. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21444835
- ↑ Jump up to: 6.0 6.1 Polonia JJ, Gama GM, Silva JA et al Sequential follow-up clinic and ambulatory blood pressure evaluation in a low risk population of white-coat hypertensive patients and in normotensives. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15812251
- ↑ Jump up to: 7.0 7.1 7.2 Mancia G et al. Long-term prognostic value of white coat hypertension: An insight from diagnostic use of both ambulatory and home blood pressure measurements. Hypertension 2013 Jul; 62:168 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23716584 <Internet> http://hyper.ahajournals.org/content/62/1/168
de la Sierra A. Definition of white coat hypertension: Ambulatory blood pressure, self-measured blood pressure, or both? Hypertension 2013 Jul; 62:16. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23716585 <Internet> http://hyper.ahajournals.org/content/62/1/16 - ↑ Jump up to: 8.0 8.1 8.2 Tanner RM, Shimbo D, Seals SR et al White-Coat Effect Among Older Adults: Data From the Jackson Heart Study. J Clin Hypertens (Greenwich). 2015 Aug 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26279070
- ↑ Stergiou GS, Asayama K, Thijs L et al Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome. Hypertension. 2014 Apr;63(4):675-82. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24420553 Free Article
- ↑ Jump up to: 10.0 10.1 10.2 Cohen JB, Lotito MJ, Trivedi UK et al Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis. Ann Intern Med. 2019. June 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31181575 https://annals.org/aim/article-abstract/2735719/cardiovascular-events-mortality-white-coat-hypertension-systematic-review-meta-analysis
Shimbo D, Muntner P Should Out-of-Office Monitoring Be Performed for Detecting White Coat Hypertension? Ann Intern Med. 2019. June 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31181573 https://annals.org/aim/article-abstract/2735721/should-out-office-monitoring-performed-detecting-white-coat-hypertension - ↑ Jump up to: 11.0 11.1 Grassi G, Quarti-Trevano F, Seravalle G et al. Sympathetic neural mechanisms underlying attended and unattended blood pressure measurement. Hypertension 2021 Oct; 78:1126. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34365811 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.17657
- ↑ Jump up to: 12.0 12.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022